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HealthPayerIntelligence News

Understanding the Basics of Accountable Care Organizations

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Accountable care organizations (ACOs) are provider-based networks which utilize data analytics and population health management strategies to increase efficiency, improve patient outcomes, and reduce healthcare costs. Originally established in...

DOJ Sues UnitedHealth over Alleged $1B Medicare Fraud

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The Department of Justice is suing UnitedHealth  for alleged Medicare Advantage fraud in a civil case.  The complaint, filed in the Western District court, is “for monies unlawfully obtained or retained from the insurers Medicare...

WI Medicaid Waiver Adds Drug Testing, Behavior Incentives

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The Wisconsin Department of Health Services (DHS) will submit a section 1115 Medicaid waiver for the 2018 enrollment period that aims to add drug testing, healthy behavior incentives, and premium payments for certain beneficiaries. The waivers...

Employers Seek Clarity, Stability in Health Insurance Market

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The nation’s largest employers are taking a second look at what type of health insurance they buy, and why.  The American Health Policy Institute (AHPI) surveyed over 400 large companies and found issues of transparency, tax credits...

CMS to Shutter Small Business Health Options Program Website

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As of 2018, HealthCare.gov will no longer host the Small Business Health Options Program (SHOP) Marketplace.   Usage of the healthcare insurance exchange by insurance producers and overall enrollment through SHOP never met anticipated...

650 Medical Groups Sign On to Abolish Medicare Budget Panel

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Over 650 medical organizations have signed a letter to Congress from the Healthcare Leadership Council (HLC) supporting the elimination of the Independent Payment Advisory Board (IPAB).  The HLC joins a chorus of support for two bipartisan...

Kaiser Permanente Will Stay in ACA Health Insurance Exchange

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Kaiser Permanente will continue to offer coverage options through the ACA health insurance exchanges during 2018, the payer and provider announced this week. “Kaiser Permanente will continue to offer coverage -- including access to our...

CMS Offers Resources for High-Risk Pools, Reinsurance Waivers

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The Centers for Medicare and Medicaid Services (CMS) has just released a checklist for states to use on applications for Section 1332 waivers.    The waivers are specifically targeted at helping states establish high-risk pools...

KY Medicaid Awarded for Exceeding Quality, Patient Care

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Kentucky’s Anthem Blue Cross and Blue Shield Kentucky Medicaid has received an award from the National Committee for Quality Assurance (NCQA) for its Medicaid managed care plan.  The award recognizes the plan’s service and clinical...

CMS Adds Stricter Health Insurance Exchange Enrollment Rules

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Slated to begin in June 2017, the Centers for Medicare and Medicaid Services (CMS) will be rolling out a pilot program aimed at tightening scrutiny of those using the special enrollment period on the ACA health insurance exchanges. The program...

Two-Thirds of Physicians Disapprove of American Health Care Act

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Two-thirds of physicians in a new Merritt Hawkins survey reported having a negative impression of the American Health Care Act (AHCA).  This includes 58 percent of physicians who have a “strongly” negative take on the newly...

Anthem Terminates Cigna Merger, but Refuses to Pay Out $1.8B

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After a court ruling in Delaware, Anthem has notified Cigna that their proposed $54 billion merger is off, but that doesn’t mean the two insurance companies are amicably parting ways. Anthem has stated that it will not pay Cigna a $1.85...

Cardiologists: Senate Must Ensure “Meaningful Insurance Coverage”

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In a letter sent to Senate leadership, American College of Cardiology President Mary Norine Walsh, MD, advised lawmakers to ensure access to “meaningful insurance coverage and quality, cost-effective care” for the nation’s patients. ...

Maine Medicaid Waiver Would Increase Patient Responsibility

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Maine will apply for a Section 1115 Medicaid waiver from the Centers for Medicare and Medicaid Services (CMS) to be granted flexibility to circumvent federal regulations and impose reforms on its Medicaid program. The state’s proposed changes...

Aetna Will Abandon All Health Insurance Exchanges for 2018

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Aetna is ending participation in the Delaware and Nebraska ACA health insurance exchanges, completing its retreat from the public marketplace.   The company also made announcements earlier this year that it would be leaving the Virginia...

Humana Expands Orthopedic Bundled Payment Program to NC, VA

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Humana will bring its value-based orthopedic bundled payment program to 11 orthopedic specialty groups in North Carolina and Virginia.  The move follows a recent expansion into Kentucky and Indiana in 2017, and Ohio and Tennessee in...

BCBS Moves into Vacant TN Health Insurance Exchange

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Blue Cross-Blue Shield (BCBS) has announced its plans to offer coverage options on Tennessee’s Affordable Care Act health insurance exchange in 2018.  The separate rating area consists of 16 counties in the greater Knoxville area....

Patient Incentives from Payers Encourage Preventive Care Visits

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To reduce payer claim costs, would you pay members to go see their doctor once a year?  That’s the premise for a wave of patient incentive programs currently being offered by health insurance companies. For healthcare insurance payers,...

Medicaid Waiver Adds More Beds For Drug Addiction Treatment

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To circumvent an obscure Medicaid requirement, seven more states applied to join California, Maryland, Massachusetts and New York to receive a Medicaid waiver to expand drug addiction treatment.   Current federal policy prohibits the...

MD Health Insurance Exchange Rates Up Double-Digits for 2018

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Patients in Maryland looking for insurance in 2018 may have bigger bills than they bargained for. The health insurance exchange rates for individual and group plans in the state have risen by up to 58 percent as payers try to cope with uncertainty,...

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